Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients

Abstract

In our patients' cohort, a single catheter ablation procedure based on CPVA using steerable sheath for catheter navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…268,328,329,330 Conversely, patients with pharmacologically controlled hypertension could have similar risk of AF recurrence postablation as those without hypertension. 279 Pooled analysis of two small studies demonstrated that renal artery denervation resulted in both sustained lowering of BP and reduction in AF recurrence postablation.…”

“…253,329,436,684,932,935,970,971,972 Because these arrhythmias do not definitively indicate therapy failure over the long term (only half of these patients will manifest later recurrences), this period is also referred to as the blanking or therapy stabilization period. 935,973 It is also important to recognize that the later AF recurrences are observed during the blanking phase, the lower the chance of long-term success.…”

“…328,329,365, 1050,1115,1116,1117 Factors that have been identified as predictors of a poorer outcome, at least in some studies, include (1) non-PAF and particularly long-term persistent AF; (2) sleep apnea and obesity; (3) increased LA size; (4) increased age; (5) hypertension; and (6) LA fibrosis as detected by cardiac MRI. 365 …”

Catheter Ablation of Lone Atrial Fibrillation

“…Several months later he was subjected to catheter ablation of AF, due to the clinical suspicion of tachyarrhythmia-related cardiomyopathy. obesity, biochemical markers of inflammation, atrial fibrosis on MRI and increased CHADS 2 and CHA 2 DS 2 -VAS C score [18,74,[80][81][82][83][84]. Therefore, among younger patients with lone AF and normal or minimally remodelled LA, not only higher efficiency but also more stable long term effects of catheter ablation can be expected.…”

Steerable Versus Nonsteerable Sheath Technology in Atrial Fibrillation Ablation

“…9,10 With discontinuous and nontransmural ablation lines being one of the reasons for recurrences of AF and atrial macroreentrant tachycardia (MRT), steerable sheaths were designed to improve access to and contact with ablation target sites. 11,12 To build up scientific evidence on the clinical use of that technology, we published data from a retrospectively matched case-control analysis indicating a significantly superior rhythm control compared with an ablation approach with a nonsteerable sheath access.…”